Interprofessional Education and Training

Carpenter, John, Dickinson, Helen, John Carpenter, Helen Dickinson

• Publisher: Policy Press
• Year: 2016
• Print ISBN: 9781447329800
• eBook ISBN: 9781447329824
• Edition: 2
• Topic: Sciences sociales
• Subtopic: Formation professionnelle

The idea that professionals in health and social care should 'learn together to work together' in 'interprofessional education' (IPE) is not new. Nevertheless, interest in this concept has grown dramatically. By learning together, professions will better understand each other and value what others bring to the practice of collaboration. Through working together more effectively, the quality of care and outcomes for users will be improved, but what is the evidence to support this? How can effective and sustainable IPE programmes be designed and run? What theoretical perspectives are useful? How can programmes be evaluated?

This essential guide provides a thorough introduction to IPE in health and social care. It examines the research on IPE in detail, providing much-needed practical advice. This second edition includes updates to research and policy internationally, examples of successful programmes and methods of evaluation, and provides readers with an essential set of IPE 'do's and don'ts'.

1

What is interprofessional education and why does it matter?

Collaborative working has assumed an important role within UK public services over the past 30 years, with successive national governments viewing greater inter-agency working as crucial to driving good government. But an awareness of the need for professions in medicine, health and social care to work together more effectively has been around for much longer, and not only in the UK (WHO, 1998). The idea that professionals should ‘learn together to work together’ – what has come to be called ‘interprofessional education’ (IPE) – is not a new idea by any means (for further discussion on this, see Szasz, 1969; Baldwin, 1996). Nevertheless, interest in this concept has grown dramatically over the last 15 years or so. As Barr et al (2011, p 5) argue,

The turn of the Century was a watershed in the short history of … IPE … in the UK … when the Labour government promoted “common learning” to be built in to the mainstream of pre-registration professional education for all the health and social care professions to help implement its modernisation strategy…. The proposition was as seductive as it was simple: learning together would deliver not only a more collaborative but also a more flexible and more mobile workforce responsive to the exigencies of practice and the expectations of management.

As this quote illustrates, IPE has been perceived as one potential solution to a number of the practical difficulties associated with collaborative working. Health and social care collaborations bring together a range of different professions ostensibly to work together around the needs of service users. However, professions often have different values and perspectives underpinning the delivery of care and informing the ways in which they view other professions. IPE is seen as a way to overcome ignorance and prejudice between health and social care professionals. By learning together, it is argued, professions will better understand each other and value what others bring to the practice of collaboration. It is often proposed that ultimately, through working together more effectively, this will improve the quality of care and outcomes for service users.

The converse of this is also suggested: not learning together is thought to have a negative impact on services and service users. High-profile inquiries have consistently cited poor inter-agency and interprofessional working as a contributing factor towards failure on behalf of particular service users, and recommendations for IPE have been made as a result. IPE is regarded as crucial within particular areas such as safeguarding children, community mental health services, older people’s services, services for disabled children and other such contexts where it is suggested that vulnerable people – often with quite high levels of need – will only receive quality of care if services are delivered by professionals who understand each other’s roles and responsibilities, so that care can be coordinated. In many cases, multiprofessional teams (also called multidisciplinary teams) provide such care. However, IPE is not restricted just to these areas of service delivery. There is also a growing interest in using IPE to improve multidisciplinary teamworking within settings such as hospitals, community-based teams and, to some degree, primary care.

This second edition of the book has been revised to reflect the advances that have been made in the theory and practice of IPE since the first edition. Updates have been made to the policy context and new research has been incorporated, with an emphasis on new systematic reviews of the sustainability of IPE and the outcomes of IPE. In particular we reflect on the growth of IPE internationally, and have included summaries of developments in Norway, Canada, the US, Japan and Australia, and examples of programmes outside the UK. The contribution of social psychological theory to programme planning has been extended in light of recent work.

Despite – or perhaps because of – the current interest in IPE, there are a number of prefixes (multi/inter/uni/trans), adjectives (professional/disciplinary) and nouns (education/training/learning/studies) that are married together in any number of ways to refer to a range of phenomena that fit broadly within this area. Each of these terms has a different meaning, but there is a tendency to use them inconsistently. McCallin (2001, p 421) suggests that this irregularity of usage is causing difficulties in terms of definition: ‘overall … descriptions in the professional literature are so diverse that meaning is murky’. To aid clarification, this chapter starts with an overview of a range of key terms that might be encountered when reading about and discussing IPE. We then go on to provide a brief exploration of the historical and policy context, examining where interest in IPE has developed from, and how it has an impact on health and social care practitioners. The chapter concludes by considering the aims of IPE, the forms it may take and some of the key theories that might underpin it. The following chapters then build on this overview in more detail. The text draws on evidence of good and bad practice throughout, and presents a number of case studies and examples of the types of materials that have been used in IPE. The intention is that the text will offer practical – yet rigorous and relevant – evidence and advice on how to initiate, run and evaluate IPE.

Key terms

In the introductory text in this series by Jon Glasby and Helen Dickinson (2014b) a range of terms are examined that relate to the ‘partnership’ phenomenon and associated definitions. The field of IPE suffers a similar fate to that of ‘partnership’ in that, as noted above, and reiterated by a range of commentators, ‘interprofessional education is bedevilled by terminological inexactitude’ (Barr et al, 2005, p xvii). Many different terms are used within the broad field of IPE, often interchangeably and inaccurately. But these terms are underpinned by different values and associated expectations and rationales. Some of those more frequently used are defined in Box 1.1 below, but this is by no means an exhaustive list. The key definition of interprofessional education is that used by Zwarenstein et al (2000) in the first – and succeeding – Cochrane reviews of research on this subject, and this is included in Box 1.1.

Box 1.1: Helpful definitions

• Uniprofessional education (UPE): occasions when professionals or students from one profession learn together.

• Multiprofessional education (MPE) (or learning): occasions when two or more professions learn side by side in parallel.

• Interprofessional education (IPE): occurs when members of more than one health and/or social care profession learn interactively together, for the explicit purpose of improving interprofessional collaboration and/or the health and wellbeing of patients or clients. Interactive learning requires active learner participation and active exchange between learners from the different professions (Zwarenstein et al, 2000).

• Transprofessional education: occasions in real practice where professional boundaries have been crossed or merged.

• Shared learning: similar to multiprofessional learning, where students or professionals learn alongside each other, but do not necessarily interact.

• Common learning: a term previously used by the Department of Health (DH) in England, which suggests that health and social care students should, in part, follow a common curriculum.

An important point to elaborate here is the distinction between IPE and MPE – IPE promotes collaborative practice between professions, while MPE is simply learning together for whatever reason, including, for example, economies of scale in which health professionals share lectures on topics of mutual interest. Although a seemingly semantic differentiation, the intent behind the purposes of MPE and IPE programmes are different, which in turn has important implications for determining content, teaching methods and evaluation.

Looking internationally, the World Health Organization (WHO, 2010, p 5) has been influential in promoting IPE, and defines IPE as occurring ‘when two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes.’ This definition is indistinguishable from that of IPE in Box 1.1, although it is important to note that the WHO’s definition does not just involve professions learning alongside each other, but also collaborating. In the UK, the Centre for the Advancement of Interprofessional Education (CAIPE) (1996) suggests that IPE is a subset of MPE, set apart by its purpose and methods. In other words, MPE is an overarching approach to education, of which IPE is a more specialised branch for particular purposes.

In practice, this means that we need to be clear about how we are using terms such as MPE or IPE, and that others also understand this. We cannot presume that all other stakeholders will interpret these concepts in the way we intend, and we should be explicit at the outset of any discussions.

Given the terminological difficulties and a recent expansion of IPE activities, a number of commentators have expressed a concern that IPE is weak in terms of setting out its aims and also the learning theories that underpin programmes. In order to be clearer about what IPE should entail, Barr (2002, p 23) produced a definition of IPE aims and methods that has now become quite widely used. Barr identifies the components of IPE as:

The application of principles of adult learning to interactive, group-based learning, which relates collaborative learning to collaborative practice within a coherent rationale which is informed by understanding of interpersonal, group, organisational and inter-organisational relations and processes of professionalisation. (Barr, 2002, p 23)

In other words, IPE should be more specific than just professions undertaking collaborative learning, but should be underpinned by a clear sense of why such a programme is being pursued and the theories that underpin this learning. Moreover, this definition also stresses that the ultimate intention of IPE is to improve collaborative practice, rather than be an end in itself (much as this series has tried to stress that collaborative working should be about specific improvement aims and objectives rather than simply an aim in itself).

History and policy background

As Barr (2002) notes, the UK IPE movement began in the 1960s as a series of discrete and predominantly local initiatives that often had differing motivations behind their establishment. These were either specific to geographic areas or challenges, or else allied with particular professions, which generally meant that IPE was viewed as important for different reasons. These early initiatives were often reactive, isolated and relatively short-lived. However, over time, education providers became more proactive and less remedial in their approaches, and we started to see postgraduate-level programmes designed more or less explicitly to promote interprofessional collaboration among qualified practitioners.

The NHS Plan (DH, 2000a) really ignited national interest in the importance of different professional groups working together to ‘modernise’ services. This document refers to one of the underlying problems of the National Health Service (NHS) being ‘old-fashioned demarcations between staff and barriers between services’, and calls for a modernised seamless service designed ‘around the needs of the patient’ (DH, 2000a, p 10). It refers not only to barriers between NHS services, but also to barriers between the NHS and local government (in particular, social care).

As the demands of society have changed with an ageing population and an increased emphasis on the long-term management of chronic illness, multiprofessional teamwork is seen as a way of enabling service users to receive a professionally coordinated and comprehensive plan of care from a range of providers (Barr et al, 2011). Education and training are an important way in which students and professionals can be better equipped to take on this role. The NHS Plan stated that a new ‘core curriculum’ would be introduced into education programmes for NHS staff, and a common foundation programme would allow students and staff to switch careers and training paths more easily (DH, 2000a, p 86). This document also makes reference to the potential for some professions (for example, nurses) to widen their remit and to take on a much broader role spanning professions. Education and training is therefore not only seen as a way to modernise services and provide them around the needs of service users, but also to change the nature of the workforce. However, the only elements of the core curriculum referred to are communication skills and learning about NHS principles and organisation, and The NHS Plan was not explicit about the precise form th...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• List of tables, figures and boxes
• Acknowledgements
• List of abbreviations
• A note on terminology
• Preface
• 1: What is interprofessional education and why does it matter?
• 2: What does research tell us?
• 3: Hot topics and emerging issues
• 4: Useful frameworks and concepts
• 5: Recommendations for policy and practice
• References